Provider Demographics
NPI:1487683165
Name:TURLEY, BRIAN TODD SMITH (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:TODD SMITH
Last Name:TURLEY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N5184 POPP RD
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:WI
Mailing Address - Zip Code:53549-9651
Mailing Address - Country:US
Mailing Address - Phone:920-674-6354
Mailing Address - Fax:
Practice Address - Street 1:184 W PLYMOUTH ST
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:WI
Practice Address - Zip Code:53549-1833
Practice Address - Country:US
Practice Address - Phone:920-674-9567
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4271-151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice